Is current UK management of oesophageal food bolus obstruction evidence based? An e-mail survey and literature review

Price, Tim; Jones, S; Montgomery, P. Q.

doi:10.1007/s00405-007-0260-x

Cited by 12 publications

(7 citation statements)

References 37 publications

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“…22 The advocacy of hyoscine butylbromide appears to stem from a recommendation in a 1997 textbook 23 that misquotes a 1991 study detailing 10 out of 16 patients given 'spasmolytics' who spontaneously disimpacted. 24 The study is questioned as a cohort of only 16 patients provides results of low statistical power and, more pertinently, none of the 5 different 'spasmolytic' drugs used in the study actually included hyoscine butylbromide.…”

Section: Hyoscine Butylbromidementioning

confidence: 99%

The management of oesophageal soft food bolus obstruction: a systematic review

Leopard

Fishpool

Winter

2011

annals

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A food bolus obstruction of the oesophagus represents a potentially serious medical problem. It is generally agreed that sharp objects becoming lodged in the oesophagus or objects with a corrosive capacity (eg batteries) should be removed urgently.1 However, the management of oesophageal soft food bolus obstruction (OSFBO) is less clear. The aim of treatment is to prevent the occurrence of potentially serious complications of bolus obstruction, including perforation and mediastinitis. These complications may occur due to mucosal ischaemia resulting from prolonged impaction or iatrogenically during surgical removal.2 In many cases, therefore, the aim of treatment is initially to manage the patient medically to encourage resolution of the obstruction.The management of patients with OSFBO frequently involves a variety of specialties, either individually or in combination. These include the emergency care, general surgery and ENT teams. Currently, however, there is no recognised guidance regarding which medications are efficacious in the resolution of OSFBO. Furthermore, the timing of administration of any medical or surgical treatment is often based entirely on clinical judgement. The aim of this study was to perform a literature review regarding the management of OSFBO. MethodsA review of the literature was performed to evaluate the published evidence regarding pharmacological and surgical treatment of OSFBO. The Singleton Hospital library information department undertook searches of the Cochrane Library, the National Center for Biotechnology Information and the US National Library of Medicine resources. The following search strategies were used: > (oesophagus OR esophagus) AND buscopan -this yielded one case study 3 and two retrospective cohort studies;4,5 > (oesophagus OR esophagus) AND (cola OR coke OR coca-cola OR effervescent OR carbonated OR gas forming) -this yielded four retrospective cohort studies 6-9 and one case report; 10 > (oesophagus OR esophagus) AND glucagon -this yielded one randomised controlled trial 11 and two further studies; RESULTSThis systematic review of the management of OSFBO shows no evidence that any medical intervention is more effective than a 'watch and wait' policy in enabling spontaneous disimpaction. Furthermore, the use of hyoscine butylbromide for OSFBO probably stems from a misquoted textbook. Surgical removal of an OSFBO is effective but not without potential risk. There is some evidence to support surgical intervention within 24 hours to prevent complications deriving from the initial obstruction. CONCLUSIONS There is a need for large double-blind, randomised, placebo controlled trials of drugs used in the medical management of OSFBO. Until the results from such trials are available, the treatment of OSFBO will remain based on inconsistent clinical judgement.

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Section: Hyoscine Butylbromidementioning

confidence: 99%

The management of oesophageal soft food bolus obstruction: a systematic review

Leopard

Fishpool

Winter

2011

annals

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“…Despite the efficacy of endoscopy as the primary intervention for FBO, conservative approaches to the management of FBO are common . This likely reflects concerns regarding the risks of endoscopy, preference of a minimally invasive approach to management, anecdotal reports of benefit, difficulty assimilating unplanned emergent cases within busy elective endoscopy workloads and unclear management algorithms that include multiple specialties, including emergency physicians, gastroenterology, upper GI surgery and otolaryngology.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Despite the efficacy of endoscopy as the primary intervention for FBO, conservative approaches to the management of FBO are common. 11 likely reflects concerns regarding the risks of endoscopy, preference of a minimally invasive approach to management, anecdotal reports of benefit, difficulty assimilating unplanned emergent cases within busy elective endoscopy workloads and unclear management algorithms that include multiple specialties, including emergency physicians, gastroenterology, upper GI surgery and otolaryngology. Conservative therapies for FBO include glucagon, effervescent beverages, hyoscine, benzodiazepines, glyceryl trinitrate and opiates; however, there is no high-quality evidence to support any of these approaches and safety concerns have been raised with some.…”

Section: Introductionmentioning

confidence: 99%

Early referral for endoscopy is the most appropriate management strategy in cases of food bolus obstruction

Fulforth

Chen

Falvey

2019

Emerg Medicine Australasia

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Objective To investigate the characteristics of patients presenting with oesophageal food bolus obstruction (FBO) who achieve early resolution of symptoms, and to assess the impact of medical therapies on the overall time course of FBO. Methods A retrospective observational study was performed in a university teaching hospital with regional acute endoscopy services. Patients presenting with symptoms of FBO were identified through clinical coding and demographic, clinical and endoscopic data extracted from the electronic medical record. The primary outcome was the time to resolution defined as the earliest of symptom resolution, endoscopic or surgical intervention or discharge. Results A total of 116 patients presented with symptoms of FBO. Twenty‐seven (23.3%) had early resolution of symptoms and were discharged from the ED without acute endoscopy, the remainder were admitted for further management. Patients discharged from the ED presented to hospital sooner after the onset of symptoms (137 vs 288 min, P < 0.05), but did not differ from those admitted in any other characteristic. Seventy‐one (61.2%) patients received medical therapy. There was no statistical difference in the time to resolution between those who received medical therapy and those who did not. Furthermore, the use of medical therapy was associated with a delay in referral for endoscopy (140 vs 100 min, P < 0.05). Conclusions Time from symptom onset to presentation is the only predictor of early resolution from FBO, while medical therapy is ineffective in relieving obstruction and may delay definitive therapy. We recommend the use of an institutional management plan to facilitate early access to endoscopy in cases of FBO.

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“…Esophageal food bolus impaction is a multidisciplinary common emergency that frequently requires presentation to the Emergency Department for diagnosis and management [ 1 ]. The estimated annual incidence rate is 13 per 100.000 persons ranking third after upper and lower gastrointestinal bleeding [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

An innovative fast track solution for food bolus impaction due to Jackhammer esophagus in an emergency department: the “Nitro-Push Blind Technique” case report

Marano

Cecchi

et al. 2016

BMC Gastroenterol

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BackgroundIn the medical literature are described only few clinical cases of esophageal food bolus impaction due to esophageal motility disorders. Moreover, the management of this condition is highly variable with no evidence in the literature to strongly support a clear defined intervention.Case presentationIn this paper we describe for the first time a case of 53-year-old male with food bolus impaction due to Jackhammer esophagus referred to emergency department. On the basis of the known esophageal past medical history as well as the absence of bones in the bolus, the patient was submitted to a new conservative treatment, the “Nitro-Push Blind Technique”.ConclusionsThe new technique performed with naso-gastric tube thrust after nitrates medication in definite clinical case supported by known functional disease, represents a safe and successful method, with short observational period to minimize exposure to potential morbidity and reduce the inpatient stay in emergency department. It should be recommended, once validated in a larger cohort, as the initial treatment of choice in the selected patients with food boneless bolus impaction in the emergency settings. Indeed, this management provides only minimal deviation from the current practice and is hence technically easy to learn and perform.

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Is current UK management of oesophageal food bolus obstruction evidence based? An e-mail survey and literature review

Cited by 12 publications

References 37 publications

The management of oesophageal soft food bolus obstruction: a systematic review

The management of oesophageal soft food bolus obstruction: a systematic review

Early referral for endoscopy is the most appropriate management strategy in cases of food bolus obstruction

An innovative fast track solution for food bolus impaction due to Jackhammer esophagus in an emergency department: the “Nitro-Push Blind Technique” case report

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